<?
$page_title="Sevadhari - Requests List";
$mindex=3;
$profile_menu=1;
?>
<?include("includes/header.php") ?>
<div colspan="3" style="color:red">Note : Please take kind permission of your BK Center In Charge where you are attending Class and send the same to itncomm@bkconnect.net with your BKITC Membership No . and other relevant details</div>

<script src="calendarDateInput.js" language="javascript"></script>
<div class="break"></div>
<form method="post" action="sevarequest_pro.php?mode=<?=$_GET["mode"]?>" name="frmSevaReg" onsubmit="return validateForm(this,0)" >
<table class="sevarequest" cellpadding="4" cellspacing="6">
<tr>
<td class="frmLabel" colspan="3"  style="background:#f2f2f2">
<input type="radio" name="seva_location" id="seva_loc_1"  value="0">
<label for="seva_loc_1" ><b>If Preferred to do Seva in Madhuban, Specify the duration</b></label></td>

</tr>
<tr>
<td class="frmLabel">From Date </td>

<td><script language="javascript">DateInput('from_date', true, 'YYYY-MM-DD')</script></td>
</tr>
<tr>
<td class="frmLabel">To Date </td>
<td>
<script language="javascript">DateInput('to_date', true, 'YYYY-MM-DD')</script>
</td>
</tr>
<tr>
<td class="frmLabel" colspan="3" style="background:#f2f2f2">
<input type="radio" name="seva_location" value="1" id="seva_loc_2" checked="true">
<label for="seva_loc_2" ><b>If Preferred to do Seva Remotely, Specify the timing</b></label></td>
</tr>
<tr>
<td></td>
<td class="frmLabel"><b>Week Days</b></td>
<td class="frmLabel"><b>Week Ends</b></td>
</tr>
<tr>
<td class="frmLabel"><b>Best Time</b></td>
<td class="frmLabel"><input type="text" size="20" class="txtbox" name="week_days_time"></td>
<td class="frmLabel"><input type="text" size="20" class="txtbox" name="week_ends_time"></td>
</tr>
<tr>
<td colspan="3" class="frmLabel"><b>Any other Information you would like to convey</b><br/>
<textarea class="txtarea" cols="80" rows="10" name="other_info"></textarea>

</td>

</tr>

	<tr>

<td colspan="2" align="right">

<p ><input value=" Submit Request " id="frmSubmit" name="submit" type="submit" class="button"/> 	
<input type="button" value="Cancel" class="button" onclick="javascript:history.back()"/></p>

</td>
</tr>

</table>


</form>

<script type="txt/javascript">
function validateForm(vForm,vMode){




}

</script>
<?include("includes/footer.php") ?>